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    Ubiquitous steroid use posing unwitting cause for glaucoma

    All corticosteroids matter when it comes to the risk of an intraocular pressure (IOP) response, and that is an important point for ophthalmologists to remember because opportunities for corticosteroid exposure are growing.

    “From the patient’s perspective and for many of our non-ophthalmology physician colleagues, there is a perception that only steroids used to treat the eye can affect the eye,” said Terri Pickering, MD, at the at the Glaucoma Symposium during the 2017 Glaucoma 360 meeting.

    “Use of steroids by any route, however, can lead to permanently increased IOP and tip patients with pre-existing glaucoma into a state of significant visual loss,” said Dr. Pickering, clinical instructor, California Pacific Medical Center, San Francisco. “Therefore, ophthalmologists need to do a better job educating patients and our colleagues in the medical community that any corticosteroid must be used with caution and careful monitoring of IOP.”

    Concern about adverse ocular effects of steroid treatment is magnified by the fact that there are many indications for their use across different specialties. Furthermore, prolonged use is common because most conditions treated with steroids are chronic diseases.

    In addition, consumer access to products containing steroids is growing. Depending on the source, the steroid content may not be identified on the label. There is still concern with legitimate products because patients do not appreciate the risks.

    “Patients are using these products without physician advice or monitoring,” Dr. Pickering pointed out. “Warnings about ocular adverse events in direct-to-consumer advertising for over-the-counter steroid products are inadequate. It is unlikely that patients are reading the package inserts to find this information.”

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